Healthcare Provider Details

I. General information

NPI: 1558747485
Provider Name (Legal Business Name): SETH MILLER MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 BROADWAY STE 165
FORT WAYNE IN
46802-0011
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-9805
  • Fax: 260-266-9815
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39003045A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: